Obamacare Will Make Ex-Cons Healthier

National Journal
Sophie Novack
Add to Briefcase
See more stories about...
Sophie Novack
Dec. 5, 2013, 3:24 p.m.

Obama­care will ex­pand health in­sur­ance cov­er­age to mil­lions of pre­vi­ously in­car­cer­ated in­di­vidu­als, and it’s set to have big im­pacts on both pub­lic safety and pub­lic budgets.

“Jail and pris­on are ex­tremely ex­pens­ive re­sponses to pub­lic health prob­lems,” said Kara Dansky, seni­or coun­sel at the Amer­ic­an Civil Liber­ties Uni­on. Un­der the Af­ford­able Care Act, Dansky said, “states and counties are able to save money and im­prove pub­lic safety. When in­di­vidu­als have ac­cess to the ser­vices they need, they are much less likely to en­gage in crim­in­al activ­ity.”

As many as 4 mil­lion former in­mates stand to be­ne­fit from new­found eli­gib­ilty for Medi­caid, ac­cord­ing to one es­tim­ate. And since men­tal health and sub­stance-ab­use is­sues will be covered un­der Obama­care, com­munity health stands to be­ne­fit.

States have the op­tion to ex­pand Medi­caid un­der the health care law, and those that opt in will ex­pand cov­er­age to all res­id­ents at or be­low 133 per­cent of the fed­er­al poverty level. Pre­vi­ously Medi­caid did not cov­er child­less adults, ex­cept in cases of dis­ab­il­ity.

Those who have been pro­cessed through the crim­in­al justice sys­tem — a pop­u­la­tion that is primar­ily lower-in­come, of­ten has more health prob­lems, and is usu­ally lack­ing cov­er­age — have a huge amount to gain from ex­pan­ded cov­er­age.

Cur­rently around 70 to 90 per­cent of the ap­prox­im­ately 10 mil­lion in­di­vidu­als re­leased from pris­on or jail each year are un­in­sured, ac­cord­ing to a Decem­ber 2013 re­port from the Coun­cil of State Gov­ern­ments Justice Cen­ter.

As a res­ult of the ACA, 6 mil­lion to 7 mil­lion of those com­ing out of jails are likely to qual­i­fy for Medi­caid, the Cen­ter for Health Care Strategies said in a present­a­tion in Septem­ber. About half of them could en­roll, fol­low­ing state de­cisions to par­ti­cip­ate, the group es­tim­ated.

The Justice De­part­ment es­tim­ates these in­di­vidu­als will com­prise about 35 per­cent of those who will qual­i­fy for cov­er­age in states ex­pand­ing Medi­caid.

The change does not im­pact those who are cur­rently in­car­cer­ated, as their care is provided by the in­sti­tu­tion and paid for by the state or county. Those in jail or pris­on are not eli­gible to en­roll in plans through the ex­changes, or to be covered by Medi­caid dur­ing their time, even if they were pre­vi­ously en­rolled. The ex­cep­tion is if they are trans­ferred out for lengthy hos­pit­al stays.

Re­pub­lic­an law­makers have ex­pressed con­cern about tax­pay­ers pay­ing for this cov­er­age, par­tic­u­larly giv­en the stigma as­so­ci­ated with in­car­cer­a­tion. House En­ergy and Com­merce Chair­man Fred Up­ton, R-Mich., and Rep. Joe Pitts, R-Pa., sent a let­ter Oct. 9 to Gene Dodaro, head of the Gov­ern­ment Ac­count­ab­il­ity Of­fice, rais­ing these con­cerns.

“The Medi­caid pro­gram is already strug­gling to meet the health care needs of our poorest and sick­est Amer­ic­ans. We must bet­ter un­der­stand the true costs of ex­pand­ing the pro­gram to any new pop­u­la­tion and weigh such costs with the com­pet­ing in­terests of our na­tion’s most vul­ner­able law-abid­ing cit­izens,” they wrote. A com­mit­tee spokes­per­son said Thursday that they await in­form­a­tion as GAO has ac­cep­ted the re­quest.

Yet the in­creased cov­er­age will ac­tu­ally save states and counties that are ex­pand­ing Medi­caid a great deal of money, and a health­i­er pop­u­la­tion would save more in the long run.

“This is really sig­ni­fic­ant for com­munit­ies be­cause if in­di­vidu­als are in­car­cer­ated in jail or pris­on, either the state or county is re­quired to pay for their health needs,” Dansky said. “Now there is the op­por­tun­ity to use fed­er­al dol­lars to cov­er health care needs of those re­leased in­to com­munit­ies.”

In­di­vidu­als in­volved in the crim­in­al justice sys­tem have high rates of chron­ic and com­mu­nic­able dis­eases, in­clud­ing tuber­cu­los­is, hep­at­it­is, and HIV, as well as men­tal health and sub­stance-use dis­orders. The Es­sen­tial Health Be­ne­fits un­der the ACA in­clude the re­quire­ments that men­tal health and sub­stance-use dis­orders be covered at par­ity with oth­er med­ic­al be­ne­fits.

Ac­cess to treat­ment for men­tal health and sub­stance-use is­sues re­duces re­cidiv­ism rates, im­prov­ing pub­lic safety and sav­ing state and loc­al com­munit­ies ad­di­tion­al fund­ing for pris­ons and jails.

Dansky says the ex­pan­sion also has the po­ten­tial for even more far-reach­ing im­pacts.

“We think [the law] presents the op­por­tun­ity to make needed changes to sen­ten­cing laws and policies,” she said. “It would en­cour­age states’ ex­pand­ing to in­crease pre­tri­al di­ver­sion and avoid in­car­cer­a­tion in the first place.”

For crimes like low-level drug of­fenses, it’s pos­sible ex­pan­ded in­sur­ance cov­er­age could lead states to em­ploy treat­ment ser­vices and avoid the costs and neg­at­ive im­pacts of in­car­cer­a­tion, though it’s still too early to eval­u­ate these pro­grams.

What We're Following See More »
CITES CONFLICT OF INTEREST
Lieberman Withdraws from Consideration for FBI Job
3 days ago
THE LATEST
MINIMUM 2 PERCENT GDP
Trump Tells NATO Countries To Pay Up
3 days ago
BREAKING
MANAFORT AND FLYNN
Russians Discussed Influencing Trump Through Aides
3 days ago
THE DETAILS

"American spies collected information last summer revealing that senior Russian intelligence and political officials were discussing how to exert influence over Donald J. Trump through his advisers." The conversations centered around Paul Manafort, who was campaign chairman at the time, and Michael Flynn, former national security adviser and then a close campaign surrogate. Both men have been tied heavily with Russia and Flynn is currently at the center of the FBI investigation into possible collusion between the Trump campaign and Russia.

Source:
BUT WHITE HOUSE MAY USE AGAINST HIM ANYWAY
Ethics Cops Clear Mueller to Work on Trump Case
5 days ago
THE LATEST

"Former FBI Director Robert Mueller has been cleared by U.S. Department of Justice ethics experts to oversee an investigation into possible collusion between then-candidate Donald Trump's 2016 election campaign and Russia." Some had speculated that the White House would use "an ethics rule limiting government attorneys from investigating people their former law firm represented" to trip up Mueller's appointment. Jared Kushner is a client of Mueller's firm, WilmerHale. "Although Mueller has now been cleared by the Justice Department, the White House may still use his former law firm's connection to Manafort and Kushner to undermine the findings of his investigation, according to two sources close to the White House."

Source:
BUSINESSES CAN’T PLEAD FIFTH
Senate Intel to Subpoena Two of Flynn’s Businesses
5 days ago
THE LATEST

Senate Intelligence Committee chairman Richard Burr (R-NC) and ranking member Mark Warner (D-VA) will subpoena two businesses owned by former National Security Advisor Michael Flynn. Burr said, "We would like to hear from General Flynn. We'd like to see his documents. We'd like him to tell his story because he publicly said he had a story to tell."

×
×

Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.

Login